Related Experiment Video
Updated: Jul 29, 2026
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
Clinical outcomes and indicators of normalization of left ventricular dimensions after Ross procedure in children
J W Brown1, M Ruzmetov, P Vijay
1Section of the Cardiothoracic Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Insights
The Ross procedure effectively treats pediatric left ventricular outflow tract disease. This surgery improves aortic valve function, reduces heart size, and offers a high survival rate for children needing aortic valve replacement.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Research
- Aortic Valve Disease
Background:
- Left ventricular outflow tract (LVOT) disease in children often necessitates aortic valve replacement.
- The Ross procedure, using autograft aortic valves, is a surgical option for pediatric LVOT disease.
- Long-term outcomes of the Ross procedure in pediatric patients require continued evaluation.
Purpose of the Study:
- To assess the echocardiographic outcomes and clinical results of the Ross procedure in pediatric patients with LVOT disease.
- To evaluate changes in aortic annulus size, valvular function, and left ventricular remodeling post-Ross procedure.
- To determine the safety and efficacy of the Ross procedure in this cohort.
Main Methods:
- Retrospective echocardiographic assessment of 50 pediatric patients (1 month to 18 years) who underwent the Ross procedure between 1993 and 2000.
- Measurements included aortic annulus size, valvular gradient, aortic insufficiency (AI), left ventricular (LV) dimensions, wall thickness, and LV mass index (LVMI).
- Clinical data on mortality and reoperations were collected.
Main Results:
- Aortic annulus size increased, while the degree of AI and LVMI decreased significantly over time.
- Peak pressure gradients across the aortic valve declined from 73 mmHg to 7 mmHg.
- LVMI regressed from 167 g/m(2) to 108 g/m(2) (P < .001) by 3 years, with no instances of LVOT stenosis.
- AI ranged from none to mild, and survival rates were high with low reoperation rates (5 reoperations).
Conclusions:
- The Ross procedure demonstrates favorable long-term outcomes in pediatric patients with LVOT disease.
- Significant regression of LV dilatation and hypertrophy, coupled with good autograft valve function, supports its use.
- The procedure is associated with good valve durability, minimal AI, and a high survival rate, making it a preferred option for pediatric aortic valve replacement.
Abstract:
Between 1993 and 2000, 50 patients (age range, 1 month to 18 years) who had left ventricular outflow tract (LVOT) disease and had undergone a Ross procedure were assessed using echocardiography. Aortic annulus size, valvular gradient, valve insufficiency, LV dimensions at end-systole and end-diastole, LV interventricular septal and posterior wall thickness, and LV mass index (LVMI) were measured. There was 1 early and 2 late deaths, and 5 reoperations. Aortic annulus size increased and degree of aortic insufficiency (AI) decreased, as did LV internal dimensions and LVMI. Peak pressure gradients declined from 73 +/- 18 mm Hg to 7 +/- 7 mm Hg, and LVMI regressed (167 +/- 6 g/m(2) v 108 +/- 6 g/m(2), P <.001) after 3 years. The degree of AI ranged from none to mild, and no patient has LVOT stenosis. Regression of LV dilatation and hypertrophy, good autograft valve function and durability, and a high survival rate suggest that the Ross procedure is preferred for most children who require aortic valve replacement.
